Antibody drug conjugate (ADC) treatment

Your cancer team can talk to you about ADC treatment and whether it is suitable for you. There are several ADCs available for different cancer types. This includes:

• gemtuzumab ozogamicin (Mylotarg^®)
• inotuzumab ozogamicin (Besponsa^®)
• brentuximab vedotin (Adcetris^®)
• polatuzumab vedotin (Polivy^®)
• loncastuximab tesirine (Zynlonta^®)
• belantamab mafodotin (Blenrep^®)
• enfortumab vedotin (Padcev^®)
• trastuzumab emtansine (Kadcyla^®)
• trastuzumab deruxtecan (Enhertu^®)
• sacituzumab govitecan (Trodelvy^®)
• tisotumab vedotin.

ADCs can also be given in combination with other types of cancer treatments, such as chemotherapy or immunotherapy. For example, this may include:

• gemtuzumab ozogamicin (Mylotarg^®) with daunorubicin and cytarabine (DA)
• pola-BR
• pola-R-CHP
• brentuximab vedotin (Adcetris^®) with doxorubicin, vinblastine and dacarbazine (BV-AVD)
• belantamab mafodotin, bortezomib and dexamethasone (BVD)
• enfortumab vedotin (Padcev^®) with pembrolizumab (Keytruda^®).

If you know the name of the drug or combination, you can use our list of treatments to find it. This gives more information about:

• how you have the treatment
• possible side effects.

Antibody drug conjugates (ADCs) are given as a drip into a vein. This is called an intravenous infusion. Your cancer team can explain what to expect.

Depending on the type of cancer, you will either have treatment:

• at a day unit or clinic as an outpatient
• during a stay in hospital.

The nurse will explain how long your treatment will take.

You may have treatment into a vein through:

• a cannula – a short, thin tube the nurse puts into a vein in the arm or hand
• a central line – a fine tube that goes under the skin of the chest and into a vein close by
• a PICC line – a fine tube that is put into a vein in the arm and goes up into a vein in the chest
• an implantable port (portacath) – a disc that is put under the skin on the chest or arm and goes into a vein in the chest.

Different ADC treatments can have different side effects.

To learn more about your specific treatment, you can search for information about the ADC or combination of drugs using our cancer treatments and drugs A to Z.

You may get the following side effects.

Some people have an allergic reaction while having ADC treatment. The first infusion is the most likely to cause a reaction, so it is usually given more slowly than later treatments.

Before treatment, you will have medicines to help prevent or reduce any reaction.

Signs of a reaction can include:

• feeling hot or flushed
• shivering
• itching
• a skin rash
• feeling dizzy or sick
• a headache
• feeling breathless or wheezy
• swelling of your face or mouth
• pain in your back, tummy or chest.

Your nurse will check you for signs of a reaction during your infusion. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, they can treat it quickly.

Sometimes a reaction happens a few hours after treatment. If you develop any of these signs or feel unwell after you get home, contact the hospital straight away on the 24-hour number.

Always call 999 if swelling happens suddenly or you are struggling to breathe.

ADC treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is called neutropenia.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible.

If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

• a temperature above 37.5°C
• a temperature below 36°C
• you feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection can include:

• feeling shivery and shaking
• a sore throat
• a cough
• breathlessness
• diarrhoea
• needing to pass urine (pee) often, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

Your white blood cell count will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.

ADC treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

• nosebleeds
• bleeding gums
• heavy periods
• blood in your urine (pee) or stools (poo)
• tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin.

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.

ADC treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia.

You may feel:

• very low in energy
• breathless
• dizzy and light-headed.

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Feeling tired is a common side effect of ADC treatment. It is often worse towards the end of treatment and for some weeks after it ends. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired.

If you feel sleepy, do not drive or use machinery.

ADC treatment may cause sickness. Your cancer team will prescribe anti-sickness drugs to help prevent or control sickness.

Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids.

If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.

ADC treatment may cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (8 glasses) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help.

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away.

ADC treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual.

ADC treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection.

Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

Contact the hospital straight away on the 24-hour number, if:

• a sore mouth or throat affects how much you can drink or eat
• your mouth, tongue, throat or lips have any blisters, ulcers or white patches.

They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

• drink plenty of fluids
• avoid alcohol and tobacco
• avoid food or drinks that irritate your mouth and throat.

ADC treatment can affect your skin. It might feel dry. You may develop a rash, which may be itchy.

Always tell your cancer team about any skin changes. They can give you advice or prescribe creams or medicines to help.

If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day.

ADC treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly tasks such as fastening buttons or tying shoelaces.

If you have these symptoms, always tell your cancer team. They sometimes need to change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends. But for some people they continue and are a long term side effect of treatment.

ADC treatment can affect how the heart works. You may have tests to check how well your heart is working. These may be done before, during and after treatment.

If the treatment is causing heart problems, your cancer doctor may give you tablets to manage these. Or they may change the type of cancer treatment you are having.

Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• breathlessness
• dizziness
• changes to your heartbeat (palpitations)
• swollen feet and ankles.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor.

Always call 999 if you have:

• chest pain, pressure, heaviness, tightness or squeezing across the chest
• difficulty breathing.

ADC treatment can cause inflammation or changes to the lungs. Contact the hospital straight away on the 24-hour number if you develop:

• a cough that does not go away
• wheezing
• breathlessness
• a fever, with a temperature over 37.5°C.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Some ADC treatments can affect how the liver works. You will have regular blood tests to check this.

Sometimes liver changes can be serious. Contact the hospital straight away on the 24-hour number if you have any of these symptoms:

• yellow skin or eyes
• feeling very sleepy
• dark urine (pee)
• unexplained bleeding or bruising
• pain in the right side of your tummy (abdomen)
• swelling in the tummy (abdomen) caused by a build-up of fluid (ascites).

If you have black or brown skin, changes in your skin colour may be less noticeable. You might first notice the whites of your eyes look yellow, or that the colour of your urine has changed.

Some people being treated for types of blood cancer such as lymphoma or leukaemia may be at risk of developing a condition called tumour lysis syndrome (TLS). The risk is highest at the beginning of treatment.

TLS happens when treatment makes large numbers of cancer cells die and break down quickly. This releases lots of waste products into the blood and can affect the kidneys and heart.

TLS can be prevented or treated. You will have regular blood tests to check for TLS. You may have:

• extra fluids through a drip
• medicines such as allopurinol tablets or rasburicase through a drip.

Drinking at least 2 litres (8 glasses) of fluid a day will also help.